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Rome Health Medical Center: Coordinated for Comprehensive Patient Care

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By Elizabeth Landry

Thursday, August 18, 2022

“The best care out there. Here.”

Rendering of Rome Health Physician Center lobby
 

That’s the motto at Rome Health, an organization that is always focused on community and striving each day to provide patients with the best care possible. This commitment will now extend to the new Rome Health Medical Center, which opens this fall.

Located at 1500 N. James St. on the hospital’s main campus, the new Medical Center brings together primary care, surgical specialists, diagnostic testing and retail pharmacy services under one roof for coordinated, comprehensive, individualized patient care.

Careful Planning

Rome Health worked with King + King Architects and the Hayner Hoyt Corporation to design a building that intuitively offers ease of access and straightforward navigation right from the start of a patient’s experience. The new design also kept the provider experience in mind.

Providers from the hospital’s existing off-campus locations will move into the new 31,000-square-foot, two-story Medical Center over the next several months, as each office integrates with the center’s new electronic medical record. The facility includes 41 exam and procedure rooms with primary care, retail pharmacy and lab services on the ground floor. Additional primary care providers, general specialists and those specializing in breast and bariatric surgery will see patients on the second floor.

The proximity of adjacent services at the hospital, including medical imaging, cardiopulmonary services and cardiology, enhances accessibility for patients who may need multiple services but also face transportation difficulties.

PATIENT-CENTERED — Rome Health Chief Operating Officer Ryan Thompson and Chief Medical Officer Cristian Andrade, MD, preview one of the exam rooms in the new Rome Health Medical Center opening in the fall. Each room will have dual monitors so the provider can share information with the patient on a large screen on the wall.
 

Close Collaboration

The Medical Center design supports providers and their care teams in delivering comprehensive care in an environment that is convenient and facilitates important healthcare discussions. Each floor is organized into separate pods, each one consisting of provider offices, a care team station and exam rooms. Allowing medical teams to quickly and easily collaborate enhances communication and supports coordinated patient care.

“This entire initiative really revolves around access to primary care and the coordination of care that comes out of that,” says Michael J. Attilio, MD, Vice President of Physician Practices at Rome Health. “This new space provides us with the opportunity to better integrate local primary care and specialty services, bring people together and have a much more collaborative and interactive environment. Providers can interact more frequently, which in primary care is very valuable. We take care of a very diverse population of individuals. Being able to simply walk next door and ask, ‘Hey, what do you think about this?’ helps us as clinicians to make better diagnoses and better decisions, which helps improve the quality of care our patients receive.”

Ryan Thompson, Chief Operating Officer, Rome Health Medical Center, says increasing ease of communication among providers and staff inherently comes with improved access to the community, as well.

“When we create an environment that supports the workflows of our physicians and nurse practitioners, it’s easier for them to just focus on our patients,” Thompson says. “Efficient workflows help us to increase capacity and offer greater access for our patients.”

TEAM-BASED CARE — Rome Health Chief Operating Officer Ryan Thompson explains how each pod in the new Rome Health Medical Center supports the providers and their care teams in providing the best care out there. Here.
 

A New Electronic Health Record System

Another major component of the new Rome Health Medical Center is an integrated ambulatory electronic health record that will replace the stand-alone systems used by its affiliated primary care, prenatal care services and specialty practices. The new system will allow clinicians to access all of a patient’s medical information within the Rome Health system, regardless of where they were treated. Moving to a single platform also provides patients access to a portal where they can securely obtain their personal health information.

The new system will also help reduce unnecessary over testing and repeat medical testing.

“The integrated health record is going to assist physicians with communication amongst each other so we’re not duplicating efforts and care for patients,” says Chief Medical Officer Cristian Andrade, MD. “There’s going to be better access to those records when patients are admitted to the hospital, reducing the cost and improving efficiency and care for patients. From a population health standpoint, the electronic health record integration also helps with standardizing care for chronic conditions with evidence-based medicine.”

As a whole, the new Medical Center and its integrated systems will create a connected healthcare experience that benefits both patients and providers — a tool to help improve the lives and health of people in Rome and its surrounding communities.

As the official opening of the medical center approaches, the healthcare team at Rome Health will grow alongside the patient population they serve. But no matter where the care is being offered, serving patients with the best, coordinated and comprehensive care will always be at the heart of Rome Health.

“The really important thing I want everyone to reflect on as we move into this space is that at the end of the day, it’s really not about the space, if you think about it. It’s about the people in that space, our people taking care of the people who depend upon us for their care,” Dr. Attilio says. “We want to provide a comfortable, welcoming, high-quality environment for the patients we serve and the healthcare professionals who deliver that care.”

Visit romehospital.org to learn more.

Firefighters: Get screened like your life depends on it

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By Martha Conway

Thursday, August 18, 2022

CRA Medical Imaging talks about firefighter health, low-dose CT Medicare expansion

CRA Medical Imaging, one of the largest diagnostic imaging practices in Central New York, strives to deliver the best care for the best patient outcomes possible. CRA Medical Imaging has zeroed in on a particular population: Firefighters. Cancer is the leading cause of line-of-duty deaths for firefighters, followed by heart disease. The Syracuse municipal health plan offers firefighters earlier access to potentially life-saving screenings, which are offered in collaboration with Crouse Medical Practice – Cardiology, Crouse Radiology Associates, Empire Dermatology, Fayetteville Dermatology and Hematology-Oncology Associates of CNY.

Screenings, like smoke detectors, save lives

Cancer is the most dangerous threat to firefighter health and safety, causing 66% of career firefighter line-of-duty deaths (LODDs) from 2002 to 2019 and 70% of LODDs for career firefighters in 2016, according to data from the International Association of Fire Fighters. Heart disease caused 18% of career LODDs for the same period.

Firefighters have a 9% higher risk of being diagnosed with cancer and a 14% higher risk of dying from cancer than the general U.S. population, according to research by the CDC’s National Institute for Occupational Health and Safety. The most prevalent cancers were respiratory (lung, mesothelioma), GI (oral cavity, esophageal, large intestine) and kidney; however, firefighters also have twice the risk of developing testicular cancer and mesothelioma; about 1.5 times the risk of developing multiple myeloma, non-Hodgkin’s lymphoma and skin cancer; and about 1.25 times the risk of developing malignant melanoma, brain cancer, prostate cancer, colon cancer and leukemia.

Most screenings — which include testing for colorectal, prostate, kidney, bladder, thyroid and lung cancers, as well as EKGs, cardiac stress tests and cancer genetics screening surveys according to age and circumstances — can be completed during annual Firefighter Screening Days, but individuals can make appointments that are more convenient for them.

Since 2005, the nonprofit Firefighter Cancer Support Network (FCSN) has assisted and provided one-on-one mentoring to thousands of cancer-stricken firefighters and their families. FCSN also delivers cancer awareness and prevention training nationwide. For more information, visit firefightercancersupport.org/resources/faq.

Updated reimbursement policies sure to improve lung cancer screening rates

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) released a detailed summary of expanded reimbursements involving low-dose computed tomography screening for lung cancer.

According to reporting by Dave Fornell in the March 11 issue of Computed Tomography, the move is expected to increase access to this critical diagnostic tool. In Fornell’s article, ACR Principal Economic Policy Analyst Alicia Blakey said there is a concerted effort to increase screenings for lung cancer and awareness of the availability of low-dose CT scans. Blakey said the goal is to find and treat lung cancer in its earliest stage, particularly in high-risk, asymptomatic individuals.

Lung cancer is the leading cause of cancer-related deaths in the U.S.; about 85% of lung cancer deaths occur in current or former cigarette smokers. The most common cause of lung cancer deaths is non-small-cell lung cancer.

CMS changes lower the screening age, shorten the length of annual cigarette consumption, expand access for commercial payers and Medicaid expansion states, and lower the age for screening to accommodate younger and disabled people, all of which will expand low-dose CT screening, particularly to historically underserved populations and people who have shorter smoking histories.

Submitting a scheduling request form (crouse.org/firefighterform/) will help expedite registration; for more information or to register by phone, contact Marianne Kokosenski at 315-472-7504 Ext. 1349 or email mkokosenski@hoacny.com.

When registering for screenings, participants may opt to get an eight-week trial membership at the YMCA of Central New York. For more information on the program and participating branches, visit crouse.org/wp-content/uploads/2022/03/Oncology-Trifold-Brochure-1-compressed.pdf.

Those needing a primary care physician may get help finding a provider by emailing navigator@crouse.org or calling 315-470-8034; visit crouse.org/providers for a list of Crouse Health Network primary care practices.

Leaders in the Field of Medical Imaging

For CRA Medical Imaging, part of their mission is to be first in the field in every way. Their staff have decades of experience, and their facilities — which are ACR-accredited in mammography, CT, nuclear medicine and PET/CT — tout the best equipment and services in ultrasound, X-ray, MRI, computed tomography, PET/CT, nuclear medicine, 3D digital mammography and interventional radiology.

Clinical quality and service to patients and referring providers are top priorities for CRA Medical Imaging, and these factors provide patients a higher standard of imaging quality, care and radiation dose protection.

CRA has locations in Syracuse, Auburn, Fulton and Oswego, where diagnostic testing including ultrasound, X-ray, MRI, CT, PET/CT, nuclear medicine, 3-D digital mammography and interventional radiology are performed in a friendly, efficient environment. For more information about CRA Medical Imaging, call 315-234-7600 or visit craimaging.com.


Phillips Vereos PET/CT Scanner

Improving Community Health

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By Kathryn Ruscitto

Thursday, August 18, 2022

So much of what we are dealing with in our society can be addressed by improving community health

Besides socioeconomic factors, the physical environment, health behaviors, and access to clinical care — when rolled together — produce good or bad health outcomes, as noted by the CDC. Clearly, we know many diseases cannot be cured, but if we prevent the illness to begin with, results include a better outcome for the patient, and reductions in the use and cost of treatment.

I spend a great deal of time focused on the social determinants of health outcomes, and specifically advocating for Lyme disease research. The emergence of new viruses, escalating drug abuse, and gun violence have also contributed to growing concerns about prevention and treatment in our communities. The list could go on and on, but strategies to improve health outcomes in one area often spill over to positive impacts in other areas. The best example is exercise and weight reduction, and the impact that has on many chronic illnesses.

Community Health Is Everyone’s Responsibility

It’s not only the health department’s job — whether local or national — to set the stage for better community health. If organizations and employers promoted more educational initiatives for tobacco cessation, physical activity, nutrition counseling, CPR, and screenings for cholesterol, blood pressure and diabetes, we would inevitably improve community health.

The CDC reports that 19% of U.S. employers currently offer tobacco cessation programs and 17% offer programs to address obesity and weight management. Surely, there’s room for growth, and plenty of resources are readily available.

Kathryn Ruscitto

Franklin Fry, Executive Director of the American Heart Association in Syracuse, suggests clinicians should remember and utilize free programs and resources offered by organizations such as the American Heart Association. In Central New York, the AHA’s priorities include addressing hypertension through programming around self-monitoring of blood pressure, improving nutritional security for SNAP users by promoting additional benefits for fruits and vegetables, and ensuring families are educated on cardiac emergency response through the teaching of Hands-Only CPR.

As our health organizations face COVID-19 and workforce shortages, the ability to offer community based screenings and health promotions has eroded. What can our practices, churches and social organizations to do help? Get behind programs you can sponsor, those that put the tools in the hands of patients to improve their health and their families’ health.

Resources

  1. cancer.org/about-us/what-we-do/health-equity.html (American Cancer Society)
  2. cdc.gov/chinav/database/index.html (CDC: Community Health Improvement Navigator)
  3. cnylymealliance.org/ (Lyme Alliance)
  4. cpr.heart.org/en/training-programs/community-programs (American Heart Association, CPR)
  5. diabetesjournals.org/care/article/45/Supplement_1/S8/138915/1-Improving-Care-and-Promoting-Health-in (American Diabetes Association)
  6. heart.org/syracuse (American Heart Association, Syracuse)
  7. rwjf.org/en/our-focus-areas/focus-areas/healthy-communities.html (RWJ, Healthy Communities)

Kathryn Ruscitto, Advisor, can be reached at linkedin.com/in/kathrynruscitto or at krusct@gmail.com.

Be Careful of the SLAPP-back

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By Laura Spring, Esq.

Thursday, August 18, 2022

Pursuing a defamation claim for a negative social media review is a hard road at best.

Social media is ubiquitous. Nearly every organization or business — including medical practices — is being reviewed by customers and patients who can easily and publicly disseminate their point of view across the internet. Sometimes those reviews seem unduly harsh or unjustified, but there are good reasons for medical practices to not launch a legal response.

Different standards govern defamation. Whether the plaintiff is a public or private figure, or the matter is one of public interest, there is generally a high bar to winning a defamation suit in the United States. Courts tend to construe ambiguous or unclear language in favor of the defendant.

There must also be an objectively false statement that can be judged as such for the plaintiff to prevail in a defamation case. A mere statement of opinion is almost certainly not enough. Subjective opinions are almost always going to be considered protected speech, which makes a review on social media difficult to prove as defamation.

Laura Spring, Esq.

Anti-SLAPP Laws Raise the Bar Even Higher

Beyond the robust First Amendment’s protection of speech, which makes winning a defamation suit difficult, many states, including New York, now have anti-SLAPP statutes that further protect speech related to public matters.

SLAPP is an acronym for “strategic lawsuits against public participation,” meaning lawsuits that have little to no legal merit, but are filed anyway in order to intimidate the defendant or inundate them with costs related to legal proceedings. SLAPP suits are a weapon in the arsenal of those with deep pockets who aim to silence opposition.

Initial New York anti-SLAPP statutes focused on speech during public meetings about land use development. In 2020, the anti-SLAPP statute was expanded to include “any communication in a place open to a public or a public forum in connection with an issue of public interest.” The statute tells the courts to interpret “public interest” as broadly as possible.

The Public Forum Expands

Social media is interpreted as a public forum, and court cases have shown that reviews of businesses on social media sites will fall into the category of “public interest.”

One recent case, Aristocrat Plastic Surgery v. Silva, determined the reviews of medical treatment performed by doctors were a matter of public interest and therefore, the negative online reviews were protected speech. Since the court determined the negative review fell under New York’s anti-SLAPP statute, the defendant was subsequently entitled to obtain damages and attorneys’ fees from the doctor who initiated the defamation claim.

The bottom line: Legal responses to negative reviews of businesses are unlikely to succeed. Perhaps more importantly, due to New York’s anti-SLAPP statute, any business owner — including a medical practice — could be on the hook for damages and legal fees if it brings a lawsuit covered by the statute. It is wise to tread carefully when considering a response to a negative review and it is almost certainly not worth bringing a lawsuit against the negative reviewer.

Spring is a partner at ccblaw in Syracuse, New York. She can be reached at lspring@ccblaw.com.

Accelerated Recovery Without Opioid Risks: How New York Surgeon Andrew Wickline Reinvented the Joint Replacement Experience

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By Elesa Swirgsdin

Friday, June 17, 2022

Andrew Wickline, MD, is raising the bar on total knee and hip replacements with game-changing protocols that minimize the need for pain medications while maximizing results.

Andrew Wickline, MD, Nicole Urbanke, RN, Jodi Pearsall, RN, Kristin Thayer, ST, Stevana Hanna, ST, Dana Siriano, RN, Paul Crescenzi, CRNA
 

Total knee and total hip replacements typically lead to painful recovery periods filled with difficult physical therapy sessions. Not only does this deter some patients from getting a procedure that can vastly improve their quality of life, but it also raises the risk of patients developing an opioid dependency after surgery.

Andrew Wickline, MD, an orthopedic joint replacement specialist at Genesee Orthopedics & Plastic Surgery in New Hartford, located about 50 miles east of Syracuse, has proven this troubling trend doesn’t have to continue. After developing Therapy-Free Total Knee Replacement, a program that virtually eliminates the need for traditional physical therapy following a joint replacement, Dr. Wickline published the lowest opioid use rates in the country for this type of procedure, with high patient satisfaction and positive long-term outcomes.

His groundbreaking protocols have also led to the lowest patient costs and the lowest complication rate in the state of New York, even among patients with a high number of comorbidities.

Responding to Patient Needs

“At the end of the day, a huge part of a doctor’s job is customer service,” Dr. Wickline says. “I asked my patients, what can I do better? The answers made me think about why we do such aggressive physical therapy after joint replacements, and if there could be a better way. That was the inspiration for developing my therapy-free program.”

Many patients told Dr. Wickline that the joint replacement surgery itself wasn’t a bad experience, but the physical therapy prescribed during recovery was nearly unbearable, especially for total knee replacements.

“I heard things like, ‘I hate therapy. It was absolutely terrible.’ Or ‘My mom won’t go back to do the other knee because she doesn’t want to go through therapy again,’” Dr. Wickline says. “I started looking at what we could do differently.”

Some patients also had to travel long distances for physical therapy, which presented a significant obstacle to a successful recovery. After developing an at-home therapy plan for these patients, Dr. Wickline found that they experienced less pain, better range of motion, and a faster overall recovery than those who followed a traditional, intensive inpatient physical therapy program. This success has been seen with patients from Pakistan, southeast Asia, Canada, the Caribbean, Texas, North Carolina, New Jersey, Maine and Pennsylvania.

 Andrew Wickline, MD

Siobhan Fitzgerald, RN, BSN, Nurse Administrator

Apex Surgical Center

Exceeding Expectations

Dr. Wickline began using a home-therapy method for all of his patients combined with a comprehensive education and optimization plan. The results showed not only an easier recovery, but patients needed drastically fewer narcotics for pain relief following surgery. In 2020, he published the results of his new study, in the Journal of Orthopaedic Experience & Innovation. It involved 386 patients who had total knee replacement. During a 12-week period, 86.3% of patients needed 10 or fewer opioid pills, while 18.9% used zero opioids.

Dr. Wickline’s results are 16 times less than the national average and five times less than the next best published opioid reduction paper from Mayo Clinic.

“I saw a new study that said the average across the country is 1,200 morphine milligram equivalents for the three-month period after total joint replacement,” Dr. Wickline says. “That’s around 160 oxycodone 5mg pills for 90 days — compared to 10 pills or less with my protocol. There is still a disconnect, and we need better opioid stewardship in New York and across the country.”

In 2021, more than 107,000 people in the United States died from opioid-related overdoses. According to some studies, between 8% and 12% of people who are prescribed opioids for pain after joint replacement may develop an addiction.

Dr. Wickline’s approach replaces the typical 90-minute physical therapy sessions three times a week with four simple 8-minute exercises once an hour. Using elevation and ice after the exercises also keeps swelling down, which further decreases pain.

“If you sprain your ankle badly, you’re not going to do a 90-minute workout three times a week,” he says. “It turns out that you don’t need to do aggressive, tortuous therapy if you control swelling. Formal therapy is best used to fine tune recovery at five to six weeks after surgery.”

More than 85% of patients in Dr. Wickline’s study did not need formal physical therapy, leading to an average personal savings of $720 in therapy copays and more than $3,000 savings to insurers. In addition, 64% of patients in the study went home the day of surgery and 91% were discharged within 23 hours. Currently, 95% of patients go home the same day their joint was replaced.

Patients who follow the program also experience significantly fewer complications.

“Our readmission rate is 1.2%. That is markedly lower than results published by some big institutions,” Dr. Wickline says. “That’s also where cost is kept down. If you get readmitted for a fracture, suddenly the cost for that patient has gone up dramatically. According to Medicare cost data, I have the lowest 90-day cost in the state, even though my patients have a higher number of medical issues.”

Contributing Success Factors

Dr. Wickline is among a small percentage of surgeons in the country performing tourniquet-free knee replacements. This practice lowers the risk of blood clots by 19%. It also reduces pain and infection risk and improves incision healing.

In addition, Dr. Wickline is the only site in New York offering personalized kinematic alignment and medial pivot knee replacement. It restores each patient’s normal anatomy of the knee and provides knee motion that most closely resembles that of the native join — without painful ligament releases that increase swelling.

Improving nutrition with branched-chain amino acid protein supplementation and specific anti-inflammatory diet changes also plays a significant role in an accelerated recovery program.

Lastly, Iovera cryoablation, a temporary freezing treatment around the knee, provides patients with three months of post-op pain reduction.

Total Hip Replacement Results

Dr. Wickline delivers similarly impressive results for patients undergoing total hip replacement. In 2020, he published another study in the Journal of Orthopaedic Experience & Innovation reporting the results of a six-week long study following 207 patients after their hip replacement. About 97% of these patients required 10 opioid pills or less, with the average being 3.5 pills per patient in the six weeks following surgery. Patients followed a home-therapy protocol and 95% were able to skip formal physical therapy at six weeks. He has used the muscle sparing anterior hip approach since 2007.

Preparing Patients for Success

Comprehensive patient education is a critical component of Dr. Wickline’s program.

“No one prepares for the Super Bowl the day before the game. They prepare for weeks ahead of time,” he says. “It’s the same with joint replacement.”

Dr. Wickline has written two separate patient books for knee and hip replacements, each about 65 pages long. The goal of the books — now in their 13th edition — is to help patients succeed with proper preparation prior to surgery. The books cover topics like nutrition, getting the living space ready, and what to expect every step of the way before and after surgery, as well as during recovery.

“They answer pretty much every question that a patient has asked over the last 20,000 plus surgeries,” Dr. Wickline says. “They are extremely comprehensive.”

The books are designed to be read at certain intervals prior to surgery, so that patients can, for example, change their diet four weeks before the procedure to set themselves up for a successful recovery. An app is currently in development for patients who prefer watching videos more than reading.

Ongoing Research

Dr. Wickline continues to study opportunities to optimize recovery protocols. His research focuses on the correlation between swelling and pain and is a main focus of his current research.

“The more you control swelling, the better the joint feels,” he says. “We’re doing 3D optical scanning where we’re looking at several different infection control protocols to see if they reduce swelling. We’re also performing bioimpedance testing to look at how much fluid is in the leg before and after surgery. It’s about creating a normative baseline so we can start adding or subtracting different things from the protocol to see what improves or worsens swelling.”

Dr. Wickline also participates in the geko Cross Therapy Registry for Edema, a clinical trial that collects data on how geko neuromuscular electrostimulation technology affects swelling.

Another research focus area centers on the effectiveness of various non-opioid pain management methods, such as pre-op cryoablation, which Dr. Wickline offers to help reduce post-op pain for up to three months without narcotics. He is involved in a study focusing on how long various pain relief methods last and what is most effective for patients with osteoarthritis.

Prominent Surgeons Adopt New Joint Replacement Protocol

After Andrew Wickline, MD, published his studies on therapy-free joint replacement, orthopedic surgeons around the country, as well as in other parts of the world, began to take a keen interest in his method.

Andrew Wickline, MD

“I was having great success with my total hip and total shoulder patients, but my total knee patients seemed to suffer,” says Chris Mellano, MD, orthopedic surgeon in Manhattan Beach, California. “I commonly heard patients say, ‘I hope I never have to do that again.’ I was searching for a way to make the experience easier and less painful.”

Dr. Mellano came across Dr. Wickline’s study on therapy-free knee replacement — and couldn’t believe what he was reading.

“A large percentage of patients used no narcotics after surgery, which is unheard of in my experience,” he says. “Most also did not require formal outpatient therapy, another astounding accomplishment.”

Dr. Mellano was further shocked to find that the patients in the study were not hand-picked to be ideal patients and instead included people of all ages, including those with multiple comorbidities.

Dr. Mellano decided to visit Dr. Wickline’s practice to observe his protocols firsthand. What he saw validated the published results and inspired him to adapt these new techniques into his own practice.

“The most important factor I learned was exceptional dedication to patient education,” Dr. Mellano says. “Patients went into surgery with a clear understanding of the procedure and how to optimize their outcome. On a surgery day, Dr. Wickline and his team efficiently performed multiple total joint replacements without sacrificing patient care in any way. I left feeling empowered by his example.”

After returning to his practice, Dr. Mellano began implementing many of Dr. Wickline’s protocols, including providing patients with educational guides.

“My results have been transformative,” he says. “The first five patients each took zero narcotics and told me that their outpatient total joint procedure was a wonderful experience.”

Far-Reaching Benefits

Dr. Mellano is not alone in his experience. Michael Engl, MPH, a board member of the elite European Knee Associates, who operates in northern Italy, recently traveled to New York to observe Dr. Wickline’s protocols in action.

“Here in Europe, total joint replacements that allow patients to leave the hospital after a few hours is very uncommon,” he says. “It was almost unbelievable. By visiting Dr. Wickline, I am convinced that the knowledge I gained is as high as that of attending international meetings. It was very inspiring to discuss the differences in our pathways.”

Stephen Howell, MD, knee arthroplasty surgeon at Adventist Health Lodi Memorial in Lodi, California, known for his role in helping develop the kinematic alignment method, was looking for a way to perform outpatient total knee replacements when COVID-19 stopped elective inpatient procedures.

“Since adopting Dr. Wickline’s protocols in July 2020, nearly all of our TKA procedures have been outpatient,” Dr. Howell says. “His pain program works synergistically with the kinematic alignment approach. These techniques complement and potentiate each other.”

Looking to the Future

Dr. Wickline hopes that more surgeons across the country will adopt his unique protocols into their practices to reduce the need for narcotics and improve patient outcomes. Several prominent surgeons have already incorporated his techniques into their own protocols, an encouraging sign (see sidebar on page 8).

“It can be hard to get people convinced because these methods are so different, and change can be scary,” Dr. Wickline says. “But the bottom line is if patients follow the program, they’re going to have great outcomes. The key is getting patients engaged. You just have to give them the winning game plan.”

Dr. Wickline earned the 2020 Excellence in Surgery award at the 9th Annual Excellence in Healthcare Awards presented by the Central New York Business Journal. Visit andrewwicklinemd.com to schedule an appointment. You can also call his personal assistant, Mrs. Lorilynn Szkotak, at 315-738-5069.

The Right Way to Curb Opioid Abuse by Americans

Did you know that your grandma could become addicted to opioids because of a knee replacement? It’s more likely than you might think. Knee replacements — with more than 1 million performed every year — nearly always require opioids for pain control. It’s no surprise that the proportion of older adults seeking treatment for opioid abuse nearly doubled in recent years, particularly as the number of joint replacements increased drastically.

Every pill surgeons order can cause substance abuse. A 10-day opioid supply carries up to a 20% risk of addiction. A 24-hour supply runs a 6% chance of addiction. By getting their wisdom teeth pulled, your teenager — consuming opioids for one day — could develop an addiction. Approximately 80% of heroin addicts first misused prescription narcotics.

I propose a radical solution …

Excerpted from an op-ed in the New York Daily News by orthopedic joint replacement specialist Dr. Andrew Wickline on how to immediately begin reducing opioid addiction. To read the full article, visit nydailynews.com and search for Wickline. Siobhan Fitzgerald, RN, BSN, Nurse Administrator

New York Medical Malpractice Market Trends

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By Jenn Negley

Friday, June 17, 2022

Frequency and severity of claims, social inflation, and tort reform are the key drivers pushing malpractice carriers to seek increases during a hard market or reductions in a soft market.

While New York was slower to transition to the soft market of the past 20 years, the good news is that the same might be true of the significant increases we are now seeing in other states. As reported by the American Medical Association, “Rates that jumped 10% or more between 2020 and 2021 were reported in 12 states.”

See below for those states, listed with the share of comparisons reflecting increases of that size:

  • Illinois: 58.9%
  • West Virginia: 41.7%
  • Missouri: 29.6%
  • Oregon: 20%
  • South Carolina: 16.7%
  • Idaho: 11.1%
  • Kentucky: 7.4%
  • Delaware: 6.7%
  • Washington: 6.7%
  • Michigan: 5.4%
  • Texas: 4.9%
  • Georgia: 3.7%


Jenn Negley

Recent unprecedented trends have upended the predictability carriers rely on to maintain their financial strength. Prior to COVID-19, the number of shock losses rose at an alarming pace due to so-called social inflation in jury awards not seen in previous years. While carriers continued to lower pricing concurrent with the drop in frequency of claims, they had not factored in the drastic increase in payout amounts.

There is now a concern, post-COVID, that there will be a significant increase in the frequency of claims, making reduced rates unsustainable. There is also a belief that because many patients delayed routine tests and treatments during the pandemic, health complications will increase as conditions progress further than what we normally see.

Most states, even in the most competitive markets, are seeing a third straight year of overall rate hikes. New York lags behind due to less competitiveness and its Department of Financial Services, which exerts more stringent control on rate filings.

Admitted carriers like The Doctors Company, a newer entrant to the marketplace that’s still aggressively pursuing market share, reduced their rates at the end of last year in the central region. While the carrier MLMIC has held steady on rates, with some selective increases per specialty, it also filed discounts through risk purchasing groups to maintain a hold on their market share. On the non-admitted risk retention group side, expect to see some increases, but overall, these carriers will look to keep “good” accounts and maintain rate flexibility, unlike admitted carriers.

All of these factors are driving rate increases in other states. In New York, while some downstate regions are the most litigious in the country, Central New York is not immune either, making it a difficult market to navigate.

It Is Never Tenable to Leave Savings on the Table

As a buyer, it’s important to keep an eye on a carrier’s financials due to the stressors this market creates. It’s also important to engage the market and take advantage of potential savings while it is available. Working with an experienced professional who specializes in malpractice insurance allows you to test the market and avoid costly mistakes. Working with an insurance broker who has a deep understanding and insight into each carrier’s appetite and rate history is key.

While New York is in some ways less dynamic, it can be very difficult to navigate without strong carrier relationships across multiple companies. Be sure to reach out to a specialist before your renewal, even if it is only to review your current policy and confirm you are receiving all the new discounts available.

For more information on your insurance options, please contact Jenn Negley, Vice President, Risk Strategies Company at 267-251-2233 or JNegley@Risk-Strategies.com.

Jenn will be at the NY MGMA convention in Verona June 29–July 1.

Patient-Centered Care

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By Kathy Ruscitto, Advisor

Friday, June 17, 2022

We have made many advancements in health care these days. Whether this involves staffing, healthcare delivery and access, or new technology and a growing sophistication with vaccines, all of these milestones benefit the patient.

Patient-centered care has emerged as the preferred healthcare framework for providing services that are effective and produce the best outcomes. Patient-centered care is more than listening and engaging the patient in their care. It also involves developing processes and making administrative decisions that improve the overall patient experience — from how a reception area is designed and how patient data is analyzed to education and communication about a diagnosis and even how a bill is explained. Most importantly, patient- or people-centered care means how the elements of the care team and social determinants are connected across time, place and discipline. That collaboration is what is so important to patients.

Connecting the Dots

We have developed a high level of specialized clinical expertise, but often the parts don’t connect. A patient with MS sees a neurologist for falls, an orthopedic surgeon for joint pain and a primary care physician for general concerns. Without some way to integrate all of this care, the patient is often left navigating a system they don’t entirely understand.

Kathy Ruscitto, Advisor

Health care must be evidence-based and patient-centered, which can be a complicated balancing act. But if the clinician understands the standards of care and how to effectively communicate them, the patient feels listened to and can better address all of their needs with the provider.

The World Health Organization has commenced a worldwide initiative to introduce patient-centered approaches in every country, meaning patient-centered care is now internationally accepted as a best practice framework.

However, to every clinician, every practice and every organization, the words patient-centered care may take on a different meaning. For example, clinical approaches to diagnosing and treating Lyme disease differ between the Infectious Disease Society of America and the International Lyme and Associated Diseases Society. The patient-centered approach calls for any clinician to listen to where the patient is with symptoms and offer care that considers all approaches.

The Institute of Medicine defines patient-centered care as: “Providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.” It starts with listening deeply to the challenges and needs of every patient, particularly of those with chronic conditions.

Patient-centered care helps set up a collaborative dynamic that meets patients’ needs. When done well, it’s a win for clinicians, a win for patients and a win for payers because this care model improves health outcomes.

Finally, and probably worthy of another discussion itself, how can we use technology to create virtual care teams around chronic conditions and improve our care plans?

Resources

  1. Institute for Patient and Family Centered Care (ipfcc.org/)
  2. Patient Engagement HIT (patientengagementhit.com/news/what-does-patient-centered-care-truly-mean)

Kathryn Ruscitto, Advisor can be reached at linkedin.com/in/kathrynruscitto or at krusct@gmail.com.

St. Joseph’s Health: Empowered, Engaged and Resilient

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By Robin Overbay

Thursday, April 14, 2022

The pandemic caused unimaginable challenges for healthcare systems across the world. In central New York, St. Joseph’s Health was up to the task.

Measures taken prior to the pandemic and meaningful adjustments made in response to COVID-19 set St. Joseph’s Health up for success and enabled them to maintain capacity and serve their community during one of the most difficult times in healthcare’s modern history.

Fostering a team approach and shared governance set the precedence of unity by allowing nurses and other staff to share concerns which would then be addressed to improve patient safety, optimize positive outcomes, ensure job satisfaction, and elevate the overall experience of patients and their families. Working this way throughout the pandemic also brought the St. Joseph’s Health team closer together, which measurably improved resiliency among staff, something still evident in the recovery phase following the initial and subsequent COVID-19 surges.

“Our nursing team here is absolutely wonderful and comfortable with the ever-changing landscape, and they are able to effectively care for and support our community,” says Jamie M. Kabanuk, DNP, MSN, RN, NEA-BC, Chief Nursing Officer at St. Joseph’s Health.

Raising the Bar for Clinical Excellence

Kabanuk believes promoting employee engagement and empowerment — in tangible ways — can directly improve patient safety and outcomes.

“We promote a shared decision-making platform here at St. Joseph’s Health, and we use our shared governance committee and our unit practice committees to elevate the voice of our bedside colleagues,” Kabanuk says, noting how this approach allows for faster and better identification of issues so changes can be made to improve patient care and experience. This approach also empowers the clinical team because they know their input is heard, valued and taken seriously.

“Our Unit Practice Council (UPC) is right down at a unit level, including our licensed staff and unlicensed staff, ancillary staff and manager/leadership staff, to be a part of bringing the unit’s voice to the higher-ups,” adds Helen “Melba” James, MHA, RN, Interim Director, Capacity Management Center at St. Joseph’s Health.

St. Joseph’s Health uses a tiered huddle approach to make it happen. First, the UPC will meet and bring ideas to their managers and leadership. Leadership then huddles and passes this information to directors at another tier level, then it travels to administrators, and on to VPs. Messages heard during the initial UPCs are also heard by practice administrators, the CEO, finance officers and human resources.

“So, it really goes all the way to the top,” James says. “Now, when those concerns are communicated and employees start to see changes, they realize they are a big voice — not a little voice — in this organization, and that there is a whole team behind them at different layers and at different levels of administration willing to help them.”

Kabanuk says shared governance was exemplified when a bedside colleague expressed the need for a designated discharge nurse who could provide support and one-on-one attention to patients during the discharge process. Assisting patients during this process was often time-consuming for staff and sometimes confusing for patients. The administrators listened and decided to provide this new service — tangible proof that they responded to the concerns of their clinicians — which improved satisfaction for both patients and staff.

“We were the ones who were holding this pandemic at bay. I told staff, ‘One day students will read about you in their epidemiology books and learn from how we conquered and overcame — so take pride in knowing that in a way, you have sealed your identity in history.”
— Yuri Pashchuk, MSN, RN, CCRN-k, Clinical Director of Medical and Surgical Services, Critical Care and Careflight at St. Joseph’s Health

Recognition and Positive Reinforcement

Celebrating staff accomplishments — in a profession where burnout and compassion fatigue pose a real threat to healthcare systems — can go a long way toward boosting morale. Positive reinforcement also incentivizes and recognizes nurses who help make the organization successful, which translates to improved patient outcomes and satisfaction.

One of the important ways St. Joseph’s Health honors its staff is to give awards:

  • The DAISY Award honors nurses who go “above-and-beyond” to provide quality, compassionate care to their patients. Nurses can be nominated by patients and/or their families, and by their colleagues.
  • The Good Catch Award, a lapel pin featuring a baseball and catcher’s mitt, gives recognition to team members who identify and bring forward issues that could risk patient safety or quality before an adverse event occurs.
  • The Sister Patricia Ann Award, named after one of the founding nuns at St. Joseph’s Health, recognizes team members who display tremendous healthcare leadership.
  • The Spirit of St. Joseph’s Award is given to those who exemplify the hospital’s values and mission.

When Rewarding Reaps Rewards

Providing a consistent show of appreciation and respect across departments may also have something to do with the acknowledgments the hospital routinely receives for clinical excellence.

“St. Joseph’s has always been a leader in quality and outcomes with Leapfrog designations, the U.S. News & World Report Best Regional Hospital designation, Magnet designation, and the Beacon awards — the highest awards for clinical excellence in critical care — for both of our critical care units,” says Yuri Pashchuk, MSN, RN, CCRN-k, Clinical Director of Medical and Surgical Services, Critical Care and Careflight at St. Joseph’s Health.

Pashchuk says Magnet-designated hospitals offer not only improved patient safety and lower patient mortality rates but also job satisfaction and more options for personal development and growth.

“All of those [designations] translate to a culture that we have developed over the years, where we set a high bar for ourselves,” Pashchuk says. “Those who have stuck with us understand that and they rise to that level and encourage others to do the same.”

“Our nurses have a voice. Our staff has a voice. Our nutritional service members have a voice. It’s not just that we focus on our licensed nurses, but we know that in order for this whole organization to work well, we must hear the voice of everyone from every department. We try to be an all-inclusive culture to improve our community.”
— Helen “Melba” James, MHA, RN, Interim Director, Capacity Management Center at St. Joseph’s Health

An Enduring Alliance Moves Beyond the Pandemic

Staff shortages and burnout aren’t new to healthcare systems, but these problems have grown exponentially in recent years. According to ECRI, an independent non-profit healthcare quality and safety organization, the top two patient safety concerns of 2022 are staffing shortages and the effect the pandemic has on a healthcare worker’s mental health.

St. Joseph’s Health recognized the growing threat and moved quickly to employ policies and procedures that would improve patient outcomes, including taking good care of its team. Prior to the pandemic, St. Joseph’s Health already had some systems in place to reduce the duration of hospital stays and nosocomial conditions, ensure adequate community support on discharge, and reduce the risk of readmissions. However, when the pandemic hit, more adjustments were made, including:

  • Introducing a new patient care tech position that enabled members without a formal healthcare education to receive in-house training to assist and reduce the burden on current staff
  • Redeploying staff from other departments that were seeing lower than usual patient volume into areas that needed more support
  • Using allied health colleagues to augment some of the work that would typically fall on their nurses

“Different executive orders brought all kinds of changes to health care,” Pashchuk says. “We needed to be agile and adapt quickly, and we needed to make sure that our staff had enough time to process that.”

Administration showed their support to frontline healthcare workers early, and it wasn’t uncommon to see the CEO, Chief Medical Officer or Chief Financial Officer rounding on these clinical units, including the COVID-19 unit.

“When we started seeing some of the first waves, it was a very scary time and we needed to be able to be very close at the elbow with our staff to make sure they knew we were in this together, no matter what level of leadership you were in,” Pashchuk says.

The C-suite donned the proper PPE and joined staff in solidarity to make sure they were visible, and that frontline staff had access to top leadership as close to real time as possible.

“Instead of coming to work in suits, we were coming to work in scrubs,” James says, adding that St. Joseph’s Health also introduced a manager-on-call initiative to share the burden more evenly. “Instead of you getting called to come in and me getting called on the weekend, how about I’m just on call for my unit and you for your unit.”

James says the change strengthened the leadership infrastructure and allowed for more uninterrupted downtime and recovery for staff members who greatly needed it.

“We definitely proved that we have each other’s backs,” she asserts. “Our managers have never been stronger, and our clinical managers continue to lean on each other to this day.”

St. Joseph’s Health administrative RN coordinators, whom James calls the unsung heroes throughout the pandemic, carried not only their own personal stress, but the stress of the staff, and that of the patients and patients’ families.

Pashchuk says he’s proud St. Joseph’s Health was prepared to help when COVID-19 cases were climbing, adding that their success was supported by a lot of hard work and processes they implemented years prior to the pandemic.

“That was something that the Department of Health and New York State watched very closely because our colleagues were at capacity,” Pashchuk says about other facilities. “St. Joseph’s was full but was able to maintain capacity and keep their doors open to serve the community for COVID-19 and other medical needs. We took a lot of pride in that, but that wasn’t something that was as obvious or as evident outside of these walls.

“Being a nurse at St. Joseph’s Health is not like being a nurse anywhere else in our community. I joined health care at St. Joseph’s health because I believe nursing can make a difference in people’s lives. We will continue to make decisions together and support the movement forward in our nursing journey.”
— Jamie M. Kabanuk, DNP, MSN, RN, NEA-BC, Chief Nursing Officer at St. Joseph’s Health

Recovery Support

St. Joseph’s Health paid close attention to staff needs and responded with a variety of support, such as adjusting policies to ensure adequate staffing and access to medical supplies. They also implemented resilience rounding for team members who were under more intense stress due to COVID-19 surges.

“Our colleagues are very dedicated to the care of the patients, often putting the care of the community over their own care, and we want to be able to support them in the programs that we are able to provide here at St. Joseph’s Health,” Kabanuk says.

St. Joseph’s Health also has a diverse employee assistance program that provides mental health services including group therapy sessions, individual counseling and psychiatric services. As a Catholic institution, St. Joseph’s Health chaplains and interfaith colleagues are available to talk and pray with staff, provide grief counseling and other support services.

At the end of the day, nurses and other team members at St. Joseph’s knew their community needed them, and they were ready to look the viral enemy in the eye during this pseudo-wartime scenario.

“They rallied around each other and knew, if not us, then who? Who is going to step up and help our community? These were our family members, our neighbors,” Pashchuk says. “Our nurses have been some of our biggest champions and leaders through not only COVID-19, but all challenges where we continue to see improvement.”

Visit jobs.sjhsyr.org for more information on joining the St. Joseph’s Health nursing team.

Crouse Health’s Addiction Treatment Center Expands Access to Services and Improves Patient Outcomes

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By Becca Taurisano

Thursday, April 14, 2022

 

Since 1963, Crouse Health has been a leader in addiction treatment services for Central New York and was the first provider in the area to offer methadone maintenance for the treatment of opioid use disorders. Now Crouse is leading the way again with a new two-story, 42,000 square- foot outpatient treatment center in Syracuse. The Bill and Sandra Pomeroy Treatment Center opened its doors in June 2021 at 2775 Erie Boulevard East and allows Crouse to expand the integration of medical services with a holistic, uplifting and healing environment that will lead to improved treatment and recovery outcomes for patients.

“One of our main goals with the new location was to expand access to services and increase outpatient capacity in a welcoming, safe and nurturing environment,” says Tolani Ajagbe, MD, Medical Director for Crouse’s Addiction Treatment Services, adding that the facility’s increased square footage will enable Crouse to provide treatment and recovery services for an additional 300-plus patients annually.

As the U.S. opioid crisis was exploding during the late 2010s, Crouse realized it was outgrowing its previous treatment center. Monika Taylor, Director of Addiction Treatment Services at Crouse, says, “We were bursting at the seams. It was apparent we needed a larger space to treat the needs of the community.”

In 2017, Crouse secured funding from the New York State Department of Health to build the new center, but then it was a matter of finding a location. Despite the growing awareness surrounding the opioid crisis, there is still a stigma attached to addiction and some communities were reluctant to have a treatment center close by. After a push to increase community awareness, the Erie Boulevard location became available and Crouse was able to build the center from the ground up, which was important to achieving their vision for the completed project. Working with architecture firm King and King, Taylor says they were able to design a space that is welcoming, fosters diversity and is free of stigma.

“The patient experience was front and center to the design,” she says. “We want our patients to feel uplifted when they walk in the door. [The new center] sends a message to people that you matter. You are someone who deserves to be here.”

“I want people to know when you go to Crouse you will not be judged; you will be treated with kindness and care beyond anything you’d ever expect. I have never seen anyone pour their heart and soul into this like they do. They want to see you succeed.”
— Greg Collins, Pomeroy Treatment Center patient recovering from addiction

Creating a Comfortable, Supportive Atmosphere

The Bill and Sandra Pomeroy Treatment Center incorporates unique features that communicate a message of hope to patients. Crouse included thoughtful details in the building’s design, like a glassed-in courtyard in the center of the building to let in natural light, inspirational quotes suggested by staff displayed on artwork and colorful glass windows to enhance the space.

In addition to designated areas for individual and group counseling, the center has a life skills laboratory with computers where vocational counselors can help patients with resume writing. There’s also an on-site fully functional kitchen and laundry facilities. Staff can teach meal preparation and laundry skills to patients who need them, particularly for those whose substance use started at an early age. A sensory room is used for meditation or a nursing mother by dimming the lights and playing soothing music.

Activity therapists can use an outdoor courtyard for movement, and planters are available outside for patients to grow vegetables in the summer.

For patients who have lost their basic living needs due to substance use, a clothing closet is available for them to access everyday wear or business clothing for an upcoming interview. A shower room was developed after speaking with existing patients who explained that some people seeking treatment are living on the streets and may not feel comfortable showering at a shelter.

“These features help our patients feel better about themselves,” says Taylor. “It helps with their dignity.”

Responding to the Pandemic

At any given time, the Pomeroy Treatment Center cares for as many as 1,300 patients, with the capacity to see 300 more. Dr. Ajagbe says he is seeing an uptick in patients seeking treatment, due to the COVID-19 pandemic.

“COVID measures meant to keep us safe impacted addiction like isolation, high stress and economic hardship. Some people self-medicated during this time,” Dr. Ajagbe says. “A direct effect was the huge spike of opioid deaths during COVID.”

In 2017, there were 70,000 deaths in the United States as a result of opioid overdose and 93,000 opioid overdose deaths in 2020. In the 12-month period ending in April 2021, 100,000 people died from opioid use.

“We continue to see the effects in Onondaga County,” Dr. Ajagbe says. “We lost 156 people from opioids in 2020 and 2021 is on pace to be higher than that. More people are trying to access care every day.”

About 50% of the patients at the Pomeroy Treatment Center are being treated for opioid use and the other 50% are seeking help for addictions to alcohol, marijuana, crack cocaine and other substances.

Dr. Ajagbe says the patients that come to the treatment center now are medically sicker, largely due to fentanyl and other substances used in drugs today. Some are also suffering from mental health issues, another side effect of the pandemic.

“We are seeing an increase in mental health issues — depression, anxiety, PTSD, trauma — because of lack of interpersonal interactions,” he says. “The substances people are using are spiked with synthetics and fentanyl that are causing damage in the brain and mental health.”

The Pomeroy Treatment Center can usually address all of their patient’s health issues in one location, whether they need medication to support treatment such as methadone, suboxone or vivitrol, medical treatment from their providers on staff, or mental health treatment.

“If a patient has a cough or sore throat, they can be seen by our medical staff,” Taylor says. “Some patients may not have a primary care provider or their doctor may be treating them differently because of their addiction. Being able to address those issues here is a plus to their overall treatment outcomes.”

Part of the mission of the Pomeroy Treatment Center is to destigmatize addiction.

“A large part of our population worldwide still sees addiction as a moral failure, rather than a chronic disease of the brain,” Dr. Ajagbe says. “Addiction is no different than other chronic diseases like hypertension, diabetes, asthma, Parkinson’s disease, multiple sclerosis, etc. They go through periods of remission and periods where they relapse. Our responsibility is to help them stabilize again.”

Dr. Ajagbe says only 10% to 12% of people with substance use disorders are in treatment and the rest are either unable to admit they need help or do not know how to access care. Dr. Ajagbe believes education about addiction is key, as well as providing 24/7 access to individuals seeking treatment.

The Pomeroy Treatment Center is open seven days a week: Monday through Thursday, 7:30 a.m.–1:30 p.m.; Friday, 5:30 a.m.–4:30 p.m.; Saturday/Sunday, 7 –10 a.m.

CRA Medical Imaging: On the Cutting Edge

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By Martha Conway

Thursday, April 14, 2022

Facilities tout state-of-the-art medical imaging technologies

Nicole Taylor, DO, reads patient files
 

Exciting things are happening in the field of medical imaging, and CRA Medical Imaging is leading the pack. One of the largest diagnostic imaging practices in Central New York, CRA Medical Imaging’s radiologists boast more than 20 years’ experience in the field and proudly deliver the highest level of care to patients with skill sets in specialty areas such as neuroradiology, breast imaging, nuclear medicine, interventional procedures, body imaging and musculoskeletal imaging.

Most of the time, they do it first.

“We strive to stay ahead of the curve, providing the most advanced imaging techniques,” says Medical Director Nicole Taylor, DO. “For example, we were the first in the area to offer PSMA scans and are continuously exploring the newest imaging techniques.”

Clinical quality and service to patients and referring providers are top priorities for the practice, a dynamic that has led CRA to establish locations in Syracuse, Auburn, Fulton and Oswego, where diagnostic testing including ultrasound, x-ray, MRI (magnetic resonance imaging), CT (computed tomography), PET (positron emission tomography)/CT, nuclear medicine, 3D digital mammography and interventional radiology are performed in a friendly, efficient environment.

“What really makes CRA special is the high quality of care that we provide,” Taylor says. “Long before I came to this group, I had heard about CRA’s reputation for providing great service to its patients and providers. Now that I’m a partner here, I see this every day. Taking good care of people is our top priority.”

Taking the lead in PSMA PET-CT

One of the cutting-edge technologies CRA offers is prostate-specific membrane antigen (PSMA) PET-CT. Approved by the Food and Drug Administration Dec. 1, 2020, the radioactive tracer gallium (ga) 68 PSMA-11 may be used in PET imaging not only in men with prostate cancer, but also in men who have been successfully treated for prostate cancer but who are suspected of having had their cancer return due to elevated PSA levels.

“Physicians should refer their patients to CRA because any of our specialized radiologists are only a phone call away,” Taylor says. “We believe that imaging is collaborative, particularly in complex disease processes, and especially when taking care of cancer patients.”

The National Institute of Health’s National Cancer Institute reported in 2020 that PSMA PET-CT accurately detected prostate cancer spread in a large clinical trial conducted in Australia. For some men with prostate cancer, the trial suggests PSMA PET-CT is a more effective approach than traditional imaging modalities ­— such as CT scans and bone scans — to detect metastases to other parts of the body (cancer.gov/news-events/cancer-currents-blog/2020/prostate-cancer-psma-pet-ct-metastasis).


Phillips Vereos PET/CT Scanner

According to Michael Hofman, MBBS, FRACP, FAANMS, professor of Nuclear Medicine at the Peter MacCallum Cancer Centre in Melbourne, as reported in the March 22, 2020, edition of The Lancet, “…use of PSMA PET-CT was more likely than the standard approach to change the strategy doctors used to treat the cancer…” Hofman says the trial results build on evidence from other studies that PSMA PET-CT is more likely to detect metastases than conventional approaches; early and more accurate test results mean more efficient and effective treatment.

Making diagnostic testing accessible to at-risk patients

CRA Medical Imaging CEO Mary Ann Drumm says the ACR reports that recent changes to the reimbursement rules for low-dose CT lung screening scans are expected to make screenings more accessible to more patients.

“Prior to the changes made by CMS, there was less than a 15% uptake rate for lung cancer screening in general, so we are definitely interested in raising awareness about the availability of low-dose CT scans,” Drumm says. “The goal of screening is to detect disease at its earliest and most treatable stage of lung cancer, particularly in asymptomatic individuals who have a high risk of developing lung cancer.”

She says lung cancer is the leading cause of cancer-related deaths in the United States, and worldwide about 85% of lung cancer deaths occur in current or former cigarette smokers.

In the Feb. 10 edition of the ACR’s Radiology Business, Marty Stempniak wrote that CMS’s final decision drops the eligible age for Medicare beneficiaries to receive lifesaving screenings by dropping the eligibility age from 55 to 50 years old and reducing the tobacco smoking history threshold from at least 30 pack-years to 20. These changes broaden lung cancer screening access for at-risk people.

It is predicted the move will improve health outcomes through earlier detection and close the gap in outcomes disparities, particularly among women, Black men and rural residents, according to Debra Dyer, MD, Chair of the ACR Lung Cancer Screening Steering Committee.

In the March 11 Health Imaging article by Dave Fornell, ACR Principal Economic Policy Analyst Alicia Blakey noted the benefits if expanding screening for lung cancer.

“These changes will expand lung cancer screening to underserved populations, such as African American women and people who do not have a long history of smoking,” Blakey says. “It is now recommended that patients younger than age 55 get screened by Medicare. When we think of Medicare, we think of age 65 and older, but there actually are growing millions of Americans who could benefit from this screening update due to disability status and end-stage renal cancer patients.”

Blakey says 3,593 facilities performed 866,954 LDCT lung screening exams in 2021 alone.

Valerie Brown, CRA Nuclear Medicine Technologist
 

Firefighter Cancer Screening Program

Drumm said cancer also is a leading cause of death among firefighters. Research suggests this population is high-risk for certain types of cancers compared to the general population, as fire settings can contain various hazardous substances, including carcinogenic chemicals from the fires themselves and — in some cases — from the foam used to extinguish fires.

The American Cancer Society and International Association of Firefighters have partnered in an initiative for early diagnosis and cancer treatment for firefighters, and CRA Medical Imaging has teamed up with Hematology Oncology Associates of Central New York and Crouse Hospital to hold local screening centers biannually for firefighters. The slogan is “Get screened as if your life depends on it, because it does.”

CRA Medical Imaging philosophy

CRA Medical Imaging is committed to investing in the latest technologies and regulations and working with referring providers for prompt results and follow-up care.

“Our staff is experienced, welcoming and kind,” Taylor says. “Patients can trust that their exams will be read by sub-specialized board-certified radiologists. We use the latest techniques to cut scan time and maximize patient comfort and satisfaction.”

Their facilities are American College of Radiology-accredited in mammography, CT, nuclear medicine and PET/CT, providing patients a higher standard of imaging quality, care and radiation dose protection.

The Future of Medical Imaging

Those in the imaging field know it holds incredible potential.

“Artificial intelligence is particularly interesting,” Taylor says. “There is still a very important and necessary human aspect of radiologic interpretation, but as technology grows and imaging examinations become more and more important in the diagnosis and treatment of diseases, AI will become an important adjunct to enhance disease detection.”


GE NM 830 Nuclear Medicine System

Taylor said she is proud to tell people she’s a physician at CRA Medical Imaging.

“We often are the first ones in the area to offer certain exams,” Taylor says. “We offer free lung cancer screening to at-risk patients who otherwise wouldn’t have access, and we have become one of the top groups in the world for PET brain imaging in dementia research.”

For more information about CRA Medical Imaging, call 315-234-7600 or visit craimaging.com. For more information about firefighter screening, visit crouse.org/firefighter/ or contact Marianne Kokosenski at 315-472-7504 x. 1349 or mkokosenski@hoacny.com.